International Epidemiology of Carbapenemase-Producing <i>Escherichia coli</i>
Angelique E Boutzoukas, Lauren Komarow, Liang Chen, Blake Hanson, Souha S. Kanj, Zhengyin Liu, Soraya Salcedo Mendoza, Karen Ordóñez, Minggui Wang, David L. Paterson, Scott Evans, Lizhao Ge, Abhigya Giri, Carol Hill, Keri Baum, Robert A. Bonomo, Barry N. Kreiswirth, Robin Patel, César A. Arias, Henry F. Chambers, Vance G. Fowler, David van Duin, Multi-Drug Resistant Organism Network Investigators, S Kanj Souha, Francois Jabbour Jean, Zhang Fujie, J Lok Judith, A Salata Robert, Stryjewski Martin, Di Castelnuovo Valentina, Millan Oñate Gutierrez Jose, Cober Eric, Richter Susan, J Anderson Deverick, Evans Beth, Hill Carol, Reich Heather, Baum Keri, Arias Rebekka, G Fowler Vance, Ordoñez Karen, T Jacob Jesse, Linghua Li, Neil Barry, Claudia Manca, Liang Chen, Desai Samit, Herc Erica, Cordova Ezequiel, R Ponisio Maria, Vichez Samuel, Laëtitia Marisa, Valderrama Sandra, Figueroa Jairo, A Arias Cesar, Qiang An, Panesso Diane, R. Kirsten, Thanh Truc, Fupin Hu, Su Jiachun, Jianping Jiang, Wang Ming-gui, Xiaogang Xu, Yang Yang, M Munita Jose, Spencer Maria, Alenazi Thamer, Alain Robert, Hersch Steven, Davies Susan, Huskins Charles, G Kerry, Patel Robin, Schmidt-Malan Suzannah, Revolinski Sara, Wortmann Glenn, C Kalayjian Robert, Weston Greg, Ostrowsky Belinda, Patel Gopi, E Furst Daniel, Kim Angela, Garcia-Diaz Julia, Salcedo Soraya, Jeffy John, Liu Zhengyin, Henderson Andrew, Louis David, Xie Qing, S Kaye Keith, Hainv Gao, Yunsong Yu, Waters Mary, C Fries Bettina, Eilertson Brandon, Kalisvar Marimuthu, Lee Chew Kean, Smitasin Nares, Ananth Tambyah Paul
Abstract
BACKGROUND: Carbapenemase-producing (CP) Escherichia coli (CP-Ec) are a global public health threat. We aimed to describe the clinical and molecular epidemiology and outcomes of patients from several countries with CP-Ec isolates obtained from a prospective cohort. METHODS: Patients with CP-Ec were enrolled from 26 hospitals in 6 countries. Clinical data were collected, and isolates underwent whole-genome sequencing. Clinical and molecular features and outcomes associated with isolates with or without metallo-β-lactamases (MBLs) were compared. The primary outcome was desirability of outcome ranking (DOOR) at 30 days after the index culture. RESULTS: Of the 114 CP-Ec isolates in Consortium on resistance against carbapenems in Klebsiella and other Enterobacterales-2 (CRACKLE-2), 49 harbored an MBL, most commonly blaNDM-5 (38/49, 78%). Strong regional variations were noted with MBL-Ec predominantly found among patients in China (23/49). Clinically, MBL-Ec were more often from urine sources (49% vs 29%), less often met criteria for infection (39% vs 58%, P = .04), and had lower acuity of illness when compared with non-MBL-Ec. Among patients with infection, the probability of a better DOOR outcome for a randomly selected patient with MBL-Ec as compared with non-MBL-Ec was 62% (95% CI: 48.2-74.3%). Among infected patients, non-MBL-Ec had increased 30-day (26% vs 0%; P = .02) and 90-day (39% vs 0%; P = .001) mortality compared with MBL-Ec. CONCLUSIONS: Emergence of CP-Ec was observed with important geographic variations. Bacterial characteristics, clinical presentations, and outcomes differed between MBL-Ec and non-MBL-Ec. Mortality was higher among non-MBL isolates, which were more frequently isolated from blood, but these findings may be confounded by regional variations.